Viral hepatitis: Clinical

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Viral hepatitis: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 26-year-old woman comes to emergency department with right upper quadrant pain and fever. For the past two weeks, after returning from a trip to India, she has been exhausted and "itchy all over". On physical exam, she has marked jaundice with tenderness to palpation in the epigastric region and right upper quadrant. Laboratory results are remarkable for elevated aminotransferases and bilirubin. If a liver biopsy were performed, what would the acidophilic bodies seen on biopsy represent?


Viral hepatitis is liver inflammation caused by a viral infection and it can either be acute or chronic, and five important causes are hepatitis A, B, C, D and E.

Acute viral hepatitis lasts for less than six months and the individual has nausea, vomiting, and right upper quadrant pain. Sometimes if there’s a high total bilirubin, it can lead to jaundice, pruritus, dark urine, and clay- colored stools.

Chronic viral hepatitis lasts for more than six months and the individual can sometimes be asymptomatic. Other times, chronic viral hepatitis can cause fever, fatigue, and loss of appetite, as well as extrahepatic symptoms like arthralgias and skin rashes.

On the physical examination, with acute hepatitis, there’s typically hepatomegaly, but with chronic hepatitis, the liver may feel normal on palpation, and if there’s cirrhosis, the lower margin of the liver can feel irregular.

A diagnostic workup for viral hepatitis includes a CBC, AST, ALT, total bilirubin and unconjugated bilirubin, alkaline phosphatase, and PT, PTT, INR.

Thrombocytopenia, prolonged PT and prolonged PTT as well as an elevated INR can be present in both acute and chronic hepatitis.

In acute hepatitis, levels of AST, ALT are over 100 international units per liter and sometimes the alkaline phosphatase and total bilirubin are elevated as well. If the total bilirubin is above 2 milligrams per deciliter, then an individual can appear jaundiced.

With chronic hepatitis, elevation of AST and ALT persists for more than six months but levels don’t usually rise above 400 international units per liter. In addition, total bilirubin and alkaline phosphatase levels can also be elevated.

During viral hepatitis, medications that are metabolized by the liver, like aspirin, or medications that can damage the liver, like acetaminophen, should be used with caution, because they can further damage the liver.



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